Prognosis of glioma

Prognosis

• most important factor determining the prognosis of patients with gliomas is the grade of the tumour
  • median survival of patients with anaplastic astrocytoma is around 2-3 years, and that of patients with GBM is approximately 1 year (1)
    
    
• although the outcome of patients with high grade gliomas remains poor, advances in surgical techniques, adjuvant treatment and molecular neuropathology in the last decade, have resulted in better outcomes
  • survival of two years or more is now seen in cohorts of patients with glioblastoma who present with good performance and neurological status, have favourable genetic mutations, such as IDH 1 mutation and methylated MGMT promoter, and undergo radical surgery with intra operative chemotherapy followed by concomitant post operative radiotherapy and chemotherapy
  • approximately 30% of adults with high-grade gliomas survive for at least 1 year, and 13% survive for 5 years
  • in patients with poor performance status, palliative care services provide a central management role
  • patients with high-grade gliomas have a better prognosis if they are younger, have a better performance status, or have a grade 3 tumour (1)
    
    
• Grade 2 gliomas
  • median survival of seven years or more is associated with younger age, tumour size of less than 6cm and preserved neurological function
  • progression to a higher grade tumour is usually the main factor confounding the prognosis of patients with grade 2 gliomas - total resection of such tumours, if technically possible, may achieve cure but will need to be done before progression occurs
    
    
• Grade 1 gliomas
  • benign - minimal risk of recurrence or progression after successful resection

Notes:

• brain tumours account for fewer than 2% of all primary cancers.

Reference:

1. NICE (June 2007). Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma
2. NICE (July 20180. Brain tumours (primary) and brain metastases in adults
3. Stupp R, Dietrich P, Ostermann Kraljevic S, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 2002; 20(5): 1375-82.